Deformable fiberscope with a displaceable supplementary device

ABSTRACT

The invention relates to a deformable endoscope that has one or more light/image transmission passages and in which at least one additional instrument is provided, wherein the unit of endoscope and additional instrument has a non-round cross-section along a longitudinal section (insertion section) to be inserted into a human or animal body orifice. The light/image transmission passage or the plurality of light/image transmission passages form—in particular together with at least one work passage—a closed unit (fiberscope part) which can be separated from the additional instrument. The fiberscope part and the additional instrument can be displaced relatively relative to one another along their longitudinal directions. A holding unit is provided for the holding and/or guiding of the fiberscope part and the additional instrument relative to one another.

BACKGROUND OF THE INVENTION

The invention relates to a deformable endoscope that has one or morelight/image transmission passages and in which at least one additionalinstrument is provided.

Gastroscopes are known, for example, which are inserted via thepatient's mouth into the esophagus and stomach for a gastroscopy. Suchgastroscopes have a central work passage into which small biopsyforceps, for example, can be inserted as an additional instrument inorder to take a tissue sample from the stomach or esophagus underobservation via the light/image transmission passage.

Disadvantages of these known endoscopes can be that their applicationpossibilities are limited to an unwanted extent and that their use is astrain on the patient. In particular, a prior sedation medication isrequired for the insertion of known endoscopes. An unintended injury tothe patient, for example to the pharyngeal mucosa, by an orally insertedgastroscope cannot always be avoided.

SUMMARY OF THE INVENTION

It is an object of the invention to provide an endoscope that offers awider range of applications than known endoscopes with a lower risk ofinjury and a more pleasant subjective perception by the patient.

This object is satisfied for an endoscope of the kind first mentioned bythe unit of endoscope and additional instrument having a non-roundcross-section along a longitudinal section (insertion section) to beinserted into a human or animal body orifice; by, furthermore, thelight/image transmission passage or the plurality of light/imagetransmission passages forming—in particular together with at least onework passage—a closed unit (fiberscope) which can be separated from theadditional instrument; by, furthermore, the fiberscope part and theadditional instrument being displaceable relative to one another alongtheir longitudinal directions; and by a holder device being provided forthe holding and/or guiding of the fiberscope part and the additionalinstrument relative to one another.

The invention thus departs from the long-held traditional view thatendoscopes have to be provided with an essentially circularcross-section. The cross-section of the insertion section of theendoscope in accordance with the invention is not rotationallysymmetrical, so that the endoscope can be better matched to the intendedapplications.

The cross-section of the insertion section is preferably matched to thecross-section of the body orifice into which the endoscope should beinserted and which generally does not have a round cross-section. Theutilization of space can thereby be optimized, in particular at thenarrowest point of the body for the insertion of the endoscope. Thisresults in a more pleasant subjective perception by the patient andthere can be more space available in the patient's body for the desireddiagnostic or therapeutic measure. A particular advantage of such amatching to the cross-section lies in the fact that a sedationmedication, relaxation agent or anesthization can be omitted in manyapplications since defense reflexes of the patients can be avoided moreeasily due to the optimized utilization of the cross-section and thespace.

Since the cross-section of the endoscope does not have a round shape, anadvantageous stability of the inserted endoscope can furthermore beachieved with respect to unwanted twisting with respect to itslongitudinal direction. An unwanted twisting of the endoscope can resultin the course of the insertion procedure with the round cross-section ofknown endoscopes. If, however, the endoscope is—as is provided by theinvention—formed asymmetrically in cross-section, the shape of the bodyorifice into which the endoscope is inserted can be utilized to block atwisting of the inserted endoscope. This facilitates the furtherinsertion of the endoscope and reduces the risk of injury.

The design of the endoscope of the invention can be realized by theadditional instrument being arranged—contrary to the design of knownendoscopes—at a non-central position within the cross-section of theinsertion section. In particular, a work passage provided for thereception of the additional instrument can be provided not at a centralposition, but in a lateral, eccentric arrangement with respect to thelongitudinal access of the endoscope.

The embodiment of the endoscope of the invention can also be achieved bythe dimension of the cross-section of its insertion section being muchlarger in one direction than the dimension in a direction orthogonalthereto, for example by a factor of at least 1.5. The cross-section can,for example, correspond approximately to an isosceles triangle or amirror-symmetrical trapezium whose corners are rounded in each case.

In a preferred embodiment, the endoscope is formed as apharingo-esophago-gastroscope for the examination of the pharynx, theesophagus or the stomach of the patient, by the cross-section of theinsertion section of the whole endoscope being matched to thecross-section of a meatus of the nose. Such an endoscope can—in contrastto conventional gastroscopy—be inserted into the pharynx and theesophagus of the patient via a meatus of the nose.

The pharingo-esophago-gastroscope of the invention offers the followingadvantages, among others:

-   a) in the nasal insertion into the pharynx and into the esophagus,    an injury to the patient, in particular to the pharyngeal mucosa,    can be avoided particularly easily due to the simultaneous optical    monitoring via the light/image transmission passage and due to the    deformability of the pharingo-esophago-gastroscope;-   b) in contrast to the oral insertion of a known gastroscope, the    nasal insertion of the endoscope of the invention does not produce    any defense reflexes, in particular no biting reflexes, in the    patient;-   c) in contrast to conventional gastroscopy, no local sedation    medication of the larynx region is required, so that the patient is    not affected in this respect by the use of the endoscope of the    invention and can leave the doctor's surgery or the clinic without    problems after the application without having to wait for a sedation    measure to wear off;-   d) when the pharingo-esophago-gastroscope of the invention is used,    there are also lower personnel requirements since the assistance of    a nurse and a helper (second nurse) can be dispensed with and no    anesthetist is required either. The use of the    pharingo-esophago-gastroscope can be carried out by one single    doctor with his practice assistant. A specifically fitted endoscopy    room (operating theater) is not necessary. The use of the    pharingo-esophago-gastroscope instead takes place in a normal    examination chair in the doctor's office. This naturally    considerably reduces the application costs;-   e) due to the optimized cross-section of the    pharingo-esophago-gastroscope of the invention and its thus    comparatively small cross-sectional area, it is perceived by the    patient as more pleasant than a conventional gastroscope which    usually has a circular cross-section of approximately 11 mm and    thereby takes up unnecessary extra room. A contribution to this more    pleasant perception is also made by the fact that the    pharingo-esophago-gastroscope is inserted nasally so that the    comparatively sensitive mouth area remains free of foreign bodies;-   f) the pharingo-esophago-gastroscope inserted through a single    meatus of the nose allows the patient to continue to breathe both    through the mouth and through the nose, namely through the    non-occupied meatus of the nose;-   g) the pharingo-esophago-gastroscope inserted nasally into the    pharyngeal cavity can be further guided into the esophagus in a    particularly simple, pleasant and non-hazardous manner when the    patient simultaneously drinks a liquid, for example water. This is    possible without problem due to the free mouth area. The drinking    process can be tracked by the physician via the light/image    transmission passage. When swallowing takes place, the    pharingo-esophago-gastroscope is guided past the larynx and the    esophagus sphincter into the esophagus;-   h) the nasally inserted endoscope allows a study which is close to    reality of the swallowing motor system, the contraction movements of    the esophagus muscles (peristole) and the associated sphincter.    These examinations can take place while using the additional    instrument and with simultaneous monitoring via the light/image    transmission passage. Such functional analyses can take place both    when drinking a liquid and when ingesting solid food. More accurate    examination results are found than with known gastroscopes since the    mouth area is not blocked by the nasally inserted    pharingo-esophago-gastroscope and since the    pharingo-esophago-gastroscope has a lower, and thus less disturbing,    cross-sectional area due to its optimized cross-section;-   i) the use of the endoscope of the invention is not limited to    diagnostic procedures, but also opens up new possibilities to study    the human or animal body. For example, the    pharingo-esophago-gastroscope matched to the meatus of the nose    allows the exploration of the new area of study of so-called    somnoscopy:    -   Since the nasally inserted endoscope continues to give the        patient the opportunity to breathe through the mouth or nose and        since it is also not felt to be particularly unpleasant by the        patient, the endoscope can be left in the patient's body        overnight without problem in order to carry out studies taking        several hours. For example, a pH measuring probe can be used as        the additional instrument of the endoscope of the invention and        can determine the pH overnight at a plurality of points along        the esophagus and in the stomach in order to check whether        unexpected local or temporal anomalies occur in comparatively        undisturbed and stationary conditions. Of course, the        possibility of an optical control via the light/image passage is        maintained with such an application.

When the endoscope is formed as a pharingo-esophago-gastroscope, it ispreferred if the base length of the basic form of the cross-section,that is, for example, the explained triangular or trapezoidal shape,amounts to a maximum of 3.5 mm. Exhaustive studies have shown that withsuch a dimension, the insertion of the endoscope into a meatus of thenose is still basically possible with all patients. It is moreoverpreferred if the maximum cross-section of the respective additionalinstruments amounts to at most approximately 3 mm, in particular amaximum of approximately 2 mm so that the additional instrument can beguided, together with the remaining pharingo-esophago-gastroscope,through a meatus of the nose of any patient without problem. Thecross-section of the additional instrument can, however, also be matchedto the individual maximum cross-section of the patient's meatus of thenose. The typical overall length of the pharingo-esophago-gastroscopeamounts, for example, to 76 cm.

The invention can also be realized in a tracheo-bronchoscope for theexamination of the trachea and the bronchial tubes. The advantages ofthe pharingo-esophago-gastroscope explained above also apply with such atracheo-bronchoscope.

The endoscope of the invention is made up of a plurality of parts,namely of a fiberscope part, which includes, as a closed unit, thelight/image transmission passage(s) and preferably one or more workpassages, and of the one or more additional instruments. Since theadditional instrument can, for instance, be set on the fiberscope part,this embodiment can also be termed a “pick-a-back system” (cf. FIG. 1).The additional instrument is here preferably located outside the actualfiberscope part.

The additional instrument can be set on the fiberscope part or, viceversa, the fiberscope part on the additional instrument in dependence onthe cross-sectional area and shape of the body orifice, for example themeatus of the nose, and the additional instrument can have a smaller orlarger cross-section than the fiberscope part.

The fiberscope part and the additional instrument(s) can be displacedrelative to one another along their respective longitudinal directions(so-called “shuttle system”). In this way, a flexible handling and avariable radius of action of the relevant additional instrument result.For example, when biopsy forceps are used as the additional instrument,a displaceability of approximately 5 cm can be sufficient to, on the onehand, retract the biopsy forceps relative to the fiberscope part toavoid hindering the monitoring of the insertion procedure via thelight/image transmission passage and to, on the other hand, extend thebiopsy forceps relative to the stationary fiberscope part in a distaldirection for the purpose of taking a sample.

A relative displaceability of approximately 35 cm can prove to beadvantageous, in particular for long-term examinations where, with astationary additional instrument, for example a pH measuring probe, onlythe fiberscope part should be displaced in order to carry out an opticalmonitoring at a certain pH measuring point without thereby disturbing orfalsifying the continuing measurement with the pH measuring probe.

To achieve a connection of the fiberscope part and the additionalinstrument(s) to form a unit, a holding device is provided at thefiberscope part or at the relevant additional instrument. The fiberscopepart and the additional instrument(s) can preferably be alternativelyfixed to one another or released from one another by means of theholding device such that a relative movement between the fiberscope partand the additional instrument is possible.

For example, a loop—for example of nylon—can be provided as the holdingdevice at the distal end of the endoscope relative to the operatingphysician and an additional instrument be held or guided therein. It ispossible to allow the loop to project out of a central or a lateralopening at the distal end of the fiberscope part.

In particular, a work passage of, for example, 1 mm can be provided atthe fiberscope part and fixation forceps of a diameter of, for example,0.8 mm be guided therein, which engage at a closed loop of an overalllength of approximately 60 mm. When this loop projects out of the workpassage and engages around an additional instrument there, the relevantadditional instrument can be fixed at the distal end of the fiberscopepart or released for a relative movement respectively via the loop by awithdrawal or insertion of the fixation forceps.

As an alternative to this, it is possible to provide within a workpassage of the fiberscope part a comparatively long loop which engagesan additional instrument at the distal end of the endoscope and isoperated, in particular tightened or released, by the physician at theproximal end of the endoscope (cf. FIGS. 5, 6 a, 6 b). The fixationforceps explained above can be dispensed with inside the work passage inthis manner.

With appropriate use of the principles explained above, it is moreoverpossible to use a line guided through a work passage instead of a loop,the line being fixedly connected to the relevant additional instrument.It can be prevented in this way that the additional instrumentunintentionally leaves the engagement by the loop when the loop isreleased.

In the embodiment of the endoscope of the invention with the fiberscopepart and the additional instrument separated from one another, it isfurthermore preferred if one or more fastening hoops are provided alongthe insertion section of the fiberscope part as holding devices in whichone or more additional instruments are respectively guided by looseengagement.

Alternatively or additionally to the use of a loop, a jacket hosesurrounding the fiberscope part completely or in part (cf. FIGS. 7 a to7 c) or a side cover shaped or fastened laterally at the fiberscope part(cf. FIGS. 6 a, 6 b) can be provided for the reception of the additionalinstrument. The jacket hose or the side cover can be formed of plasticand/or elastically. Furthermore, the jacket hose or the side cover canbe provided along the whole insertion section of the endoscope or alongonly one or more parts thereof.

In the event that the jacket hose or the side cover extends only along apart section of the endoscope, the jacket hose or the side cover can beformed displaceably with respect to the fiberscope part. It can therebybe ensured, for example in the use of the endoscope as apharingo-esophago-gastroscope, that the jacket hose or the side cover isalways arranged within the meatus of the nose and extending up to thepharyngeal cavity, and indeed irrespective of the penetration depth ofthe fiberscope part.

If, for example in the nasal insertion of thepharingo-esophago-gastroscope, the displaceable jacket hose is firstarranged at the front end, that is, at the distal end of the fiberscopepart, the jacket hose can maintain its position in the meatus of thenose from a certain penetration depth of the fiberscope part onwards,while the fiberscope part is inserted even further, for example for theobservation of the esophagus. Even if the fiberscope part issubsequently retracted appropriately for the observation of the pharynx,the jacket hose maintains its position and is thus again arranged alongthe distal end of the fiberscope part. Only if the fiberscope part iscompletely pulled out of the meatus of the nose, is the jacket hosesimultaneously taken along by the distal end of the fiberscope part.

The particular advantage of this embodiment lies in the fact that ineach instance an additional instrument can be inserted without a problemand without pain along the fiberscope part, through the jacket hose andvia the meatus of the nose into the pharyngeal cavity. The jacket hosenamely prevents an injury to the meatus of the nose and to thepharyngeal cavity by the additional instrument, and the distal end ofthe additional instrument cannot unintentionally release from thefiberscope part due to the curvature to be overcome.

The explained displaceability of the jacket hose can be realized by thejacket hose being able to be displaced with respect to both thefiberscope part and the additional instrument and by covering thefiberscope part and optionally the additional instrument as a loose hosesection. The side cover can, for example, be displaceably connected tothe fiberscope part via a simple or a double rail-groove connection.Moreover, an abutment element, for example an annular broadening, can beprovided at the proximal end of the jacket hose or the side cover inorder to prevent a complete disappearance into the meatus of the nose.The endoscope can furthermore have a fixation device, for example ascrew, via which the jacket hose or the side cover can be temporarilyfixed with respect to the fiberscope part.

At least one groove and a rail corresponding thereto can furthermore beprovided as the holding device to hold or guide the fiberscope part andthe additional instrument and can respectively extend along the wholeinsertion section of the endoscope or along one or more parts thereof(cf. FIGS. 8, 9). One or more holding clamps can also be provided at thefiberscope part or at the additional instrument instead of the groove(cf. FIGS. 12, 13).

The holding device provided at the fiberscope part and the additionalinstrument can also be formed by one or more permanent magnets, forexample made of an iron or nickel alloy, which cooperate with at leastone counter-element made of a permanently magnetic or magnetic material,for example steel, aluminum or titanium.

In a particularly simple embodiment, this counter-element can be formedby the additional instrument or the fiberscope part itself. It ismoreover possible to provide the permanent magnets or thecounter-elements at a plurality of sections of the fiberscope part or ofthe additional instrument. The permanent magnet, the counter-element orboth can have a covering of plastic to avoid a direct contact of themagnetic materials used and to reduce both the static friction and thesliding friction prevailing between the additional instrument and thefiberscope part.

Furthermore, a catch element and a hook element can be provided as theholding element at the fiberscope part, on the one hand, and at theadditional instrument, on the other hand, or vice versa. It is possiblein this way to insert, in particular to pull along, the hookedadditional instrument into the body orifice by means of the fiberscopepart. The additional instrument can subsequently be released in order tocarry out movements and examinations independent of the position of thefiberscope part.

The catch element and the hook element are preferably each arranged atthe distal end of the fiberscope part or the additional instrumentrespectively. The hook device can be formed, for example, by a laterallyprojecting undercutting lug and the catch element by a laterallyprojecting button lug engaging as required into the undercutting lug. Ifthe catch element and the hook device are formed in a manner flatteningtowards the proximal end of the endoscope, the pulling of the fiberscopepart or of the additional instrument out of the body orifice can takeplace particularly easily and safely.

It is naturally also possible to combine a plurality of the holdingdevices at one single endoscope.

The object underlying the invention is also satisfied for an endoscopeof the kind initially mentioned by the unit of endoscope and additionalinstrument having a non-round cross-section along a longitudinal section(insertion section) to be inserted into a human or animal body orificeand by the light/image transmission passage or the plurality oflight/image transmission passages and the additional instrument forminga closed unit (cf. FIG. 10).

A non-round cross-section of the insertion section, which is inparticular matched to the cross-section of the body orifice or a meatusof the nose, is therefore also provided with this embodiment.

However, this endoscope forms, optionally together with one or more workpassages, a closed unit so that when the endoscope is used for itsintended purpose, the additional instrument is not separated from itsown fiberscope part. This closed unit can be surrounded along itsinsertion section by a common jacket hose, for example of plastic, andit differs outwardly from a conventional gastroscope in particular by anon-round cross-section of the insertion section. The additionalinstrument can naturally also be formed displaceably with respect to theremaining endoscope in this embodiment (cf. FIG. 11 a).

Each of the embodiments of the endoscope of the invention explainedabove can have at least one work passage into which an auxiliary meansor an additional instrument can be inserted or which can serve for thecarrying out of lavages or for the aspiration of bodily fluids.

The additional instrument named in connection with the invention can,but need not, form a part of the endoscope of the invention. Biopsyforceps, an aspirator/injector probe, a pH measuring probe, a manometricprobe—for example for the examination of the esophagus peristole—, aBilitec measuring probe for the measurement of the bilirubin content, alaser probe or other surgical instruments for therapeutic measures canbe provided as the additional instrument. Moreover, a plurality ofadditional instruments, for example biopsy forceps and a pH measuringprobe, can also be provided as a result of the optimized spaceutilization of the endoscope of the invention.

The known division into a light transmission passage on the one hand andan image transmission passage on the other hand can naturally beprovided for the light/image transmission passage(s). For example, oneor more light guides can form a light transmission passage. The imagetransmission passage can likewise be formed by light guides andassociated optical systems or it can have an opto-electronic imageconverter at the distal end of the endoscope and correspondingelectrical supply and transmission lines.

The endoscope of the invention can furthermore have one or more Bowdencable systems for the active lateral alignment. In this case, the swiveldirection can coincide with the direction of the larger or the smallercross-sectional dimension of the endoscope. With an endoscope to beinserted nasally, it is of advantage with respect to the change indirection required for the passage through the pharyngeal cavity if theendoscope can be actively swivelled at least in the direction of thelarger cross-section dimension of the endoscope.

The endoscope of the invention, with its special advantages, can be usedin many areas of endoscopy, for example in bronchoscopy. An advantageousapplication possibility also lies in the rinsing of body cavities, forexample of the Eustachian tube or the maxillary sinus. The invention canfurthermore be used in surgery, in particular for the carrying out ofsterile work with the aid of additional instruments with simultaneousoptical monitoring.

The invention is described below by way of example with reference to thedrawings.

BRIEF DESCRIPTION OF THE DRAWINGS

FIGS. 1, 8, 10, 12, 14 and 16 are schematic side views respectively ofan endoscope of the invention;

FIGS. 2, 6 b, 9, 11 a, 11 b and 13 show in each case a section takenalong the plane II—II of FIG. 1, the plane VI—VI of FIG. 6 a, the planeIX—IX of FIG. 8, the plane XI—XI of FIG. 10, the plane XI—XI of FIG. 10or along the plane XIII—XIII of FIG. 12;

FIGS. 3 a and 3 b are detailed views of the region III of FIG. 1;

FIG. 4 is a schematic front section through a human nose;

FIGS. 5 and 6 a are detailed views corresponding to FIGS. 3 a and 3 brespectively of a further endoscope;

FIGS. 7 a to 7 c are sectional views corresponding to FIG. 2 of furtherendoscopes;

FIGS. 15 a, 15 b, 15 c and 15 d are in each case a section taken alongthe plane XV—XV of FIG. 14 for different embodiments;

FIG. 17 is a detailed view of the region XVII of FIG. 16; and

FIG. 18 shows the lower side of the distal end of the additionalinstrument of FIG. 16 in a detailed view.

DESCRIPTION OF THE PREFERRED EMBODIMENTS

FIG. 1 shows a side view of a pharingo-esophago-gastroscope of theinvention. This has a fiberscope 11 with an elongate insertion section13 and a proximal operating part 15. The open ends of two lighttransmission passages 17 and of an optical image transmission passage 19as well as the ends—on the operator side—of fixation forceps 21 and aBowden cable 23 are shown at the operating part 15, with theirrespective extents within the insertion section 13 of the fiberscope 11not being shown in FIG. 1.

The endoscope of FIG. 1 further has an additional instrument 25 in theform of elongate biopsy forceps. This additional instrument 25 isconnected to the fiberscope 11 at the distal end of the endoscope via aloop 27 and close to the operating part 15 by means of a fastening hoop29.

FIG. 2 shows in a section through the insertion section 13 of theendoscope of FIG. 1 that the fiberscope 11 has a flexible jacket hose 31as an outer cover and a central work passage 33 in which the fixationforceps 21 are guided. The Bowden cable 23 is not shown here.

FIGS. 3 a and 3 b each show detail views of the region III of FIG. 1,that is, of the distal end of the endoscope. The fixation forceps 21guided in the work passage 33 hold the loop 27. This projects out of thefiberscope 11 and engages loosely around the biopsy forceps 25 to allowa relative movement of the fiberscope 11 and the biopsy forceps 25 (FIG.3 a). The loop 27 is pulled deeper into the work passage 33 by pullingback the fixation forceps 21 relative to the fiberscope 11 so that thefree length of the loop 27 is reduced and the biopsy forceps 25 arefixed at the distal end of the fiberscope 11 (FIG. 3 b). A differentkind of loop holding can naturally also be provided instead of thefixation forceps 21.

The endoscope of FIGS. 1 to 3 b formed by the fiberscope 11 and theadditional instrument 25 can be inserted into the pharynx andsubsequently into the esophagus and the stomach of a patient via ameatus of the nose. This manner of application is described in thefollowing with reference to FIG. 4. This shows a frontal section of anose having a nasal septum 35, two middle conchae 37 and two inferiorconchae 39. The inferior nasal conchae 39 and the nasal septum 35 eachbound an inferior meatus of the nose 41. An endoscope can be insertedinto such an inferior meatus of the nose 41, preferably into therespectively larger one.

Due to the ultimately elongate cross-section of the meatuses of the nose41, an endoscope of comparatively large cross-section 43 can be insertedif this cross-section—as shown in FIG. 4—does not have a circular shape,but a shape adapted to the relevant body orifice 41. In other words,more or larger additional instruments or light/image transmissionpassages can be inserted through the meatus of the nose with theendoscope formed in this manner than with a conventional fiberscope ofround cross-section due to the improved utilization of area.

The overall cross-section of the endoscope of FIG. 1 is accordingly notcircular, but—as visible from FIG. 2 for the unit of fiberscope 11 andadditional instrument 25—modelled on the cross-section 43 shown in FIG.4. The matched cross-section of the endoscope also gives this stabilitywith respect to an unwanted rotation around its longitudinal axis. Thisis in particular of advantage with an active curvature and alignment ofthe endoscope by means of a Bowden cable.

If therefore the endoscope of FIG. 1 is inserted—as shown for thecross-section 43 in FIG. 4—via the meatus of the nose 41, then theflexible additional instrument 25 can be guided from the distal end ofthe fiberscope 11 via the loop 27, and indeed by a correspondingactuation of the Bowden cable 23. At the same time, the relevant bodyregion can be illuminated in a known manner via the light transmissionpassages 17 and can be observed via the image transmission passage 19and a corresponding optical system and video technique.

It must be noted with reference to the endoscope of FIG. 1 that while itis also possible to take a sample via the fixation forceps 21 guided inthe central work passage 33, the work passage 33 of the fiberscope 11typically has an inside diameter of only 1 mm. The fixation forceps 21of accordingly less than 1 mm outside diameter can only take mucoustissue. In contrast, the biopsy forceps 25 of the endoscope of theinvention can also take samples from deeper tissue layers due to itslarger diameter.

Further embodiments of the endoscope of the invention are described inthe following with reference to FIGS. 5 to 18, with same or similarelements as in FIGS. 1 to 3 b each being characterized by the samereference numerals.

The embodiment of FIG. 5 differs from the endoscope of FIG. 1 in thatthe loop 27 is not held by a separate pair of fixation forceps 21, butis ultimately guided in one line through the work passage 33 up to anoperating part (not shown). The work passage 33 does not open at thedistal end face here, but at a side section of the distal end of thefiberscope 11.

A single loop 27 without fixation forceps is also provided in theembodiment of FIG. 6 a. The loop 27 is—in contrast to FIG. 5—not guidedin a central work passage, but within a side cover 45 shaped at thefiberscope 11. This principle is also illustrated in the frontalsectional view of FIG. 6 b. The chamfered opening of the side cover 45at the distal end of the fiberscope 11 can be closed by an end piece(dummy) if the additional instrument 25 and thus the loop 27 are notrequired.

FIG. 7 a shows a further endoscope of the invention in a cross-sectionalview of its insertion section. A fiberscope 11 and an additionalinstrument 25 are also provided here as substantially separatecomponents which are connected to one another via an elastic commonjacket hose 31. As can be seen from FIG. 7 b, this jacket hose 31compresses on the removal of the additional instrument 25 in order toserve as an outer cover of only the fiberscope 11.

It is shown in FIG. 7 c that the jacket hose 31—similar to the sidecover 45 of FIGS. 6 a and 6 b—can also be provided only at one part ofthe periphery of the fiberscope 11 in order to optionally accept anadditional instrument there.

In the endoscope of FIG. 8, a fiberscope 11 and an additional instrument25 are formed in the form of an aspirator/injector probe as units whichare independent of one another and which are only connected to oneanother by a common holding device. As the sectional view of FIG. 9shows, this holding device is formed by a guide lug in the form of arail 47 formed at the additional instrument 25 and, on the fiberscope 11side, by a corresponding groove 49. The groove 49 extends along thelongitudinal direction of the fiberscope 11 by a much larger length thanthe length of the rail 47 so that a longitudinal displacement of thefiberscope 11 and the additional instrument 25 relative to one anotheris only possible within predetermined limits.

With this endoscope, a stabilizing device can be provided outside thebody, in particular close to the operating part 15, for the additionalstabilization of the fiberscope 11 and the additional instrument 25.This stabilization device can likewise be formed by a groove-rail systemand can preferably be clipped to the fiberscope 11 and/or the additionalinstrument 25.

FIG. 10 furthermore shows an endoscope which, in contrast to theembodiments of FIGS. 1 to 9, is formed as a single closed unit and whoseinsertion section 13 has, in accordance with the invention, anon-circular cross-section. An additional instrument 25—for examplebiopsy forceps—is provided for this endoscope which can have a muchlarger cross-sectional diameter in comparison to additional instrumentsof corresponding conventional endoscopes. This is possible since thenon-rotationally symmetrical cross-section of the endoscope allows amore flexible arrangement of the additional instrument 25, of thelight/image transmission passages 17, 19 and of the Bowden cable 23inside the insertion section 13, with the additional instrument 25 notnecessarily being arranged at a central point.

The endoscope of FIG. 10 can, for example, have the cross-section shownin FIG. 11 a. Here, a light transmission passage 17, an imagetransmission passage 19 and an additional instrument 25 guided inside awork passage 33 form a unit which is surrounded by a jacket hose 31 andwhich is similar to an isosceles triangle or a trapezium with roundedcorners.

The cross-section of FIG. 11 b likewise possible for the endoscope ofFIG. 10 has a comparable, substantially triangular shape. The additionalinstrument 25 is here fixedly integrated in the endoscope, which cannevertheless—as visible in FIG. 10—be deformed and laterally aligned. Inthe special embodiment of FIG. 11 b, two light transmission passages 17,an image transmission passage 19 and a separate rinsing passage 51 arefurthermore provided.

FIG. 12 in turn shows an embodiment having an additional instrument 25independent of the fiberscope part 11. The additional instrument 25has—similar to the rail-groove connection of FIGS. 8 and 9—a pluralityof holding clamps 53 which are distributed at equal intervals over itslength and which each project laterally from the additional instrument25 and engage around a rail 47 formed along the fiberscope part 11. Ascan be seen from the cross-sectional view of FIG. 13, the holding clamps53 have a C-shaped cross-section and the rail 47 has a T-shapedcross-section.

A side cover 45, which facilitates the placing of the additionalinstrument 25 onto the rail 47 of the fiberscope part 11 and supportsthe insertion of the fiberscope part 11 with the fitted additionalinstrument 25 into the relevant body orifice, in particular the meatusof the nose, is formed on the fiberscope part 11 along a proximalsection thereof. The additional instrument 25 fitted in this way can bemoved as desired and without limitation along the fiberscope part 11.The additional instrument 25 can in particular be subsequently pushed inwhen the fiberscope part 11 is already inserted into the body orifice,with the fiberscope part 11 providing the required guidance.

In the endoscope of FIG. 14, biopsy forceps made of a magnetizable metalare provided as the additional instrument 25. As can be seen from thecross-sectional view of FIG. 15 a, a permanent magnet 55 is integratedin the fiberscope part 11 which can magnetically attract the additionalinstrument 25. The additional instrument 25 is guided along thefiberscope part 11 due to this magnetic cooperation.

The additional instrument 25 is guided by a side cover 45 along aproximal part of the fiberscope part 11 for additional guidance andstabilization. The permanent magnet 55 is provided only section-wisealong a distal part of the fiberscope part 11 such that an intentionalrelease of the distal end of the additional instrument 25 from thefiberscope part 11 is possible at the relevant sections.

Since the jacket hose 31 surrounding the fiberscope part 11 and merginginto the side cover 45 also serves as a covering 57 of the permanentmagnet 55, the friction between the fiberscope part 11 and theadditional instrument 25 is reduced and the relative movabilityincreased.

FIG. 15 b shows the cross-sectional view of a modified embodiment inwhich the side cover 45 is fastened to the jacket hose 31 via a doublerail-groove connection and can thus be displaced along the wholefiberscope part 11. The side cover 45 can in this way always be left inthe meatus of the nose 41 (FIG. 4) of the patient irrespective of theinsertion depth of the fiberscope part 11 in order to facilitate thesubsequent guiding of the additional instrument 25 without pain orinjury. The rails of the side cover 45, which are T-shaped incross-section, extend over the whole length of the side cover 45. Thecorresponding grooves at the fiberscope part 11 extend along the wholeinsertion section 13 up to just before the distal end of the fiberscopepart 11.

FIG. 15 c shows a further embodiment in which the side cover 45 isshaped at the jacket hose 31. In contrast to the embodiment of FIG. 15a, the unit of side cover 45 and jacket hose 31 is here pulled looselyover the fiberscope part 11 so that this unit can be displaced relativeto both the fiberscope part 11 and the additional instrument. A stopper(not shown) at the distal end of the fiberscope part 11 can prevent anunintentional release from the fiberscope part 11.

FIG. 15 d shows a further example corresponding to the embodiment ofFIG. 15 b of a rail-groove connection of a jacket hose 31 with aseparate side cover 45 which is only provided along a part section ofthe fiberscope part 11 and can be displaced relatively thereto. In thisexample, a rail is provided on the fiberscope part 11 side, while acorresponding groove is arranged at the side cover 45. This reversedarrangement of rail and groove can reduce the risk of injury in someapplications.

In the embodiment of FIG. 15 d, the rail is moreover formed by theactual permanent magnet 55 rounded in cross-section. A volume reductionis thereby achieved within the fiberscope part 11 and the additionalinstrument 25 can contact the permanent magnet 55 directly at leastoutside the side cover 45 in favor of a higher magnetic attraction.

Finally, it is alternatively possible in the embodiment of FIG. 15 d forthe side cover 45 to engage around the only rail 55 in the manner of aclamp without a covering web 57 such that the additional instrument 25can also lie directly on the rail 55 within the side cover 45.

FIGS. 16 and 17 show an endoscope having a manometric probe as theadditional instrument 25. The distal end thereof is hooked to the distalend of the fiberscope part 11. A hook device 59 in the form of alaterally projecting undercutting lug is provided at the additionalinstrument 25 for this purpose and grips under, and partly around, acatch element 61 of the fiberscope part 11. The catch element 61 isformed by a button lug which projects laterally from the fiberscope part11 and which is inserted along the longitudinal direction of theadditional instrument 25 into an elongate slot 63 formed at theundercutting lug 59. The position of the hooked catch element 61 can beseen from FIG. 18, which shows the lower side of the additionalinstrument 25 in a detailed view.

The additional instrument 25 hooked in this way can be inserted into thebody orifice jointly with the fiberscope part 11. If the additionalinstrument 25 is thereafter pushed beyond the fiberscope part 11, thecatch element 61 leaves the hooking device 59. As a result, it ispossible to work with the additional instrument 25 independently of thefiberscope part 11 and the additional instrument 24 can be removed fromthe body orifice again, in particular independent of the fiberscope part11.

1. A deformable endoscope comprising a closed fiberscope part housing atleast one light/image transmission passage and at least one workchannel, at least one additional instrument, the fiberscope part beingseparable from the at least one additional instrument, a holding deviceincluding at least one permanent magnet associated with one of thefiberscope part and the at least one additional instrument and at leastone counter-element made of magnetic material associated with the otherone of the fiberscope part and the at least one additional instrument,the holding device holding and/or guiding the fiberscope part and the atleast one additional instrument relative to one another, the fiberscopepart and the at least one additional instrument forming a unit when notseparated from each other which has a non-round cross-section along alongitudinal insertion section that is to be introduced into a bodyorifice, the permanent magnet and the at least one counter-element beingdisplaceable relative to one another in a longitudinal direction of theunit for longitudinally displacing the fiberscope part and the at leastone additional instrument relative to each other.
 2. An endoscope inaccordance with claim 1 wherein the additional instrument can bealternatively fixed at the fiberscope part by means of the holdingdevice or released from the fiberscope part to allow relative movementin a longitudinal direction of the additional instrument and thefiberscope part.
 3. An endoscope in accordance with claim 1 wherein oneof a groove and a holding clamp and a corresponding rail orcorresponding rail segments are provided as a holding device at thefiberscope part and at the additional instrument.
 4. An endoscope inaccordance with claim 1 wherein the counter-element is an integral partof one of the additional instrument and the fiberscope part; and/orwherein the permanent magnet is provided at a plurality of sections ofthe other one of the additional instrument and the fiberscope part. 5.An endoscope in accordance with claim 1 including one of a jacket hoseand a side cover provided at the fiberscope part as a holding device forthe acceptance of the additional instrument, the one of the jacket hoseand the side cover extending along at least a part of the insertionsection of the endoscope.
 6. An endoscope in accordance with claim 1wherein the jacket hose surrounds both the fiberscope part and theadditional instrument.
 7. An endoscope in accordance with claim 5wherein the jacket hose is elastic with respect to its diameter.
 8. Anendoscope in accordance with claim 5 including a rail-groove connectionwhich renders at least one of the jacket hose and the side coverdisplaceable relative to the fiberscope part.
 9. An endoscope inaccordance with claim 1 wherein a cross-section of the insertion sectionis matched to the body orifice.
 10. An endoscope in accordance withclaim 1 wherein a cross-section dimension of the insertion section islarger in one direction than in a direction orthogonal thereto.
 11. Anendoscope in accordance with claim 1 wherein the additional instrumentcomprises at least one of biopsy forceps, an aspirator/injector probe, apH probe, a pressure measuring instrument and a Bilitec measuring probe.12. An endoscope in accordance with claim 1 wherein the additionalinstrument is provided laterally spaced with respect to a center of thecross-section of the insertion section.
 13. An endoscope in accordancewith claim 10 including a Bowden cable for activating swiveling theendoscope in the direction of its larger cross-sectional dimension. 14.An endoscope in accordance with claim 9 wherein the endoscope comprisesa pharingo-esophago-gastroscope for examining the pharynx, esophagusand/or stomach, and wherein a cross-section of the insertion section ismatched to a cross-section of a meatus of a human nose.
 15. An endoscopein accordance with claim 10 wherein the cross-section of the insertionsection corresponds to one of an isosceles triangle and amirror-symmetric trapezium, each including rounded corners and a basehaving a length of no more than approximately 3.5 mm.
 16. An endoscopein accordance with claim 11 wherein a greatest cross-section dimensionof the additional instrument is no more than about 3 mm.
 17. Anendoscope in accordance with claim 16 wherein the greatest cross-sectiondimension is no more than approximately 2 mm.
 18. An endoscope inaccordance with claim 1 wherein the fiberscope part and the additionalinstrument are displaceable relative to each other by up toapproximately 35 cm in their longitudinal directions.
 19. An endoscopeaccording to claim 1 wherein the fiberscope part and the additionalinstrument are displaceable relative to each other by a length of up toapproximately 5 cm.
 20. An endoscope according to claim 1 wherein thelight/image transmission passage comprises at least one separate lighttransmission passage and at least one separate image transmissionpassage.
 21. An endoscope in accordance with claim 1 including a plasticcovering for at least one of the permanent magnet and thecounter-element.
 22. A deformable endoscope comprising a closedfiberscope part housing a light/image transmission passage and a workchannel, an additional instrument, the fiberscope part being separablefrom the additional instrument, a holding device including a permanentmagnet and a counter-element made of magnetic material associated withthe fiberscope part and the additional instrument, holding and/orguiding the fiberscope part and the additional instrument relative toone another, the fiberscope part and the additional instrument forming aunit when not separated from each other, the permanent magnet and thecounter-element being displaceable relative to each other in alongitudinal direction of the unit for longitudinally displacing thefiberscope part and the additional instrument relative to each other.